Improved medicines have helped many people with
live longer, but treating older adults with HIV presents some unique challenges.
The challenges related to diagnosing
in older adults have been well documented. In many instances, both doctors and patients are uncomfortable discussing risk factors, such as unprotected sex and injection drug use, and the symptoms of HIV can mimic symptoms of other conditions common in older adults.
Once a diagnosis is made, however, there are additional challenges for older adults with HIV and the doctors who treat them. The most effective combination of drugs can interact with medicines these adults frequently take for a host of other conditions, such as high blood pressure
The protease inhibitors that are a critical part of treating HIV inhibit an enzyme in the liver that metabolizes medicines, raising the risk of drug interactions, says Karl Goodkin, MD, PhD, who works with elderly HIV patients at the University of Miami.
"Usually, you just avoid prescribing the drugs that interact," says Dr. Goodkin. "You don't have that option here. You have to prescribe the drugs.
and diet can also interact with these antiretroviral medicines. We are in a quandary right now. As a result, we're entering a whole new area of research to define what's appropriate to do."
HIV drugs may also increase the risk of certain conditions, such as high cholesterol
, high triglyceride levels
, kidney stones
, inflammation of pancreas, and liver damage. Plus, the volume and range of medicines that elders take also increase the risk of drug interaction "tremendously," according to Dr. Goodkin.
Remembering to Take Medicine
There is also the issue of getting patients to remember to take all of their medicine.
"One of the most common reasons HIV patients do not take their meds is 'I forgot,'" says Lori Fantry, MD, PhD, medical director of Baltimore's Evelyn Jordan Center at the Infectious Disease Clinic. Forgetting to take medicines can be very serious for someone with HIV since the medicines work to decrease the amount of virus in the body.
Some Good News
There is good news, however, on two fronts. Patients who take their medicine "have a very good chance of getting a good response," says Dr. Fantry. And older adults may experience the same benefits from treatment as do younger patients. Seniors generally have a better acceptance about taking their HIV medicine than do younger people, Dr. Fantry explains, because they are already used to a daily routine of taking pills.
"The elderly people in our clinic clearly have a responsible attitude toward their disease," she says. "They may need more support to do it, but once you put the supports in place with the social worker, pill boxes and reminders, they seem to do well."
There have also been significant advances in reducing the number of pills that need to be taken to control the illness. "We've come a long way from 20 pills a day," says Dr. Fantry. "We have a regimen where we can get good control with just one pill in the morning and one in the evening. You cannot do that with everyone. One regimen is seven pills a day, but it is much better than we had just a few years back. The news is clearly not all negative. Every year, it gets a little easier to take medicine."
HIV/AIDS Treatment Information Service
National Institute of Allergy and Infectious Diseases
Canadian AIDS Society
Canadian HIV/AIDS Information Centre
Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010.
Gebo KA, Justice A. HIV Infection in the Elderly.
Curr Infect Dis Rep. 2009;11(3):246-54.
Gebo KA, Moore RD. Treatment of HIV infection in the older patient.
Expert Rev Anti Infect Ther
Indinavir. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/. Updated June 28, 2010. Accessed April 7, 2011.
Ritonavir. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/. Updated June 28, 2010. Accessed April 7, 2011.
Stavudine. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/. Updated January 6, 2011. Accessed April 7, 2011.
Ship JA, Wolff A, Selik RM. Epidemiology of AIDS in Older Persons.
Journal of Acquired Immune Deficiency Syndromes.
Silverberg MJ, Leyden W, Horberg MA, DeLorenze GN, Klein D, Quesenberry CP Jr. Older age and the response to and tolerability of antiretroviral therapy.
Arch Intern Med.
Walker AS, Doerholt K, Sharland M, Gibb DM. Collaborative HIV Paediatric Study (CHIPS) Steering Committee. Response to highly active antiretroviral therapy varies with age: the UK and Ireland Collaborative HIV Paediatric Study.
Wood D. Medications for AIDS. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated March 10, 2011. Accessed April 7, 2011.